Interweave Implementation Guide
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Resource Profile: InterweaveEncounter

Official URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Interweave-Encounter Version: 0.1.0
Active as of 2024-03-08 Computable Name: InterweaveEncounter

Interweave Encounter resource profile.

  Status: Active: Approved (STU)

Introduction

This profile sets minimum expectations for the Encounter resource.

The Encounter is a key resource - as it explains the who, where, when, and why of care that has been provided. Not only is the Encounter resource valuable in itself, but it also acts as a point of reference for linking to other clinical resources.

Its main use in our region at present is for acute care, where it can be used to describe inpatient, outpatient and emergency encounters.

As of this writing Encounters are not being used by Social Care - which instead uses a model based around the Episode of Care. See the Episode of Care profile for further details.

The Encounter is a complex FHIR Resource – and one which offers significant flexibility to support different representations. The FHIR guidance on anticipated usage is helpful and should be read as background, see https://www.hl7.org/fhir/STU3/encounter.html. As this states: “The expectation is that for each domain of exchange, profiles are used to limit the flexibility of Encounter to meet the demands of the use case”. Before looking at the data items in detail, it is therefore necessary to establish some overall guidelines on how the Encounter resource type will be used

Encounter Start/End

Whilst there is an intuitive understanding of what constitutes the start / end of an Encounter, it is challenging to establish a rigorous definition. Nevertheless, the following guidelines cover key points discussed to date:

  • An Encounter covers a period of continuous care

  • A change in care-setting constitutes a change of Encounter. (This would include moving from Emergency to Inpatient to Outpatient within a hospital – as indicated by the “class”)

  • A change in location within the same care setting does NOT constitute a change of Encounter. (For example moving between beds and/or wards within a hospital inpatient stay. This would instead be modelled using the “location” sub-structure of the Encounter)

  • Involvement of additional clinicians does NOT constitute a separate Encounter. For example, suppose a hospital inpatient is visited by a dietician during their stay:

    • As a major contributor to the encounter the dietician would be referenced as one of the participants
    • As a minor contributor the dietician would be referenced as the author of a CarePlan, performer of an Observation, or assessor of a ClinicalImpression. These in turn would be linked to the Encounter.

Encounter Structure and hierarchy

Any discussion of Encounters inevitably has to consider the topic of how Encounters are structured and grouped.

  • The FHIR Encounter Resource includes the “partOf” field, which allows Encounters to be linked into structures and hierarchies.
  • It is also possible to link to an Episode of Care

There is a need to balance the desire to accurately model the complexity of real-life vs the need to provide a simple model which is easy for Data Consumers to understand and to reliably display. Experience suggests that offering a plethora of varying complex hierarchical structures from different care settings makes the task of a Data Consumer extremely challenging.

The core of the approach is therefore a simple flat list of Encounters. Two options are then offered to enrich this with different types of groupings:

  • Core Model - Simple flat list of Encounters

    This is the basic model which all Data Providers and Consumers MUST support. It consists of a simple flat list of Encounters with no hierarchy whatsoever.

    • Much of the value comes from this list and, for Direct Care purposes at least, it is not difficult for a clinician to look at the times and locations and deduce what has occurred.
    • A important use-case is messaging-based consumers - eg Ambulance Transfer of Care and Subscription Notifications. These consumers see the world as a real-time stream of Encounter-based events. In this world-view it is difficult to comprehend hierarchy - and indeed the ultimate set of interrelationships may not even be known as the initial Encounter event unfolds. It is therefore extremely important that all of the necessary information can be conveyed as a “flat” stream of Encounter messages.

    The basic model is therefore of standalone Encounters which have a full set of information populated to give a complete picture of what occurred.

    A specific implication of this is in the use of the “hospitalization” structure which, despite the name, can be used to convey important admission and discharge information relevant to any care-setting:

    • If the Encounter includes an Admission event, then the relevant portion of the hospitalization structure MUST be populated
    • If the Encounter includes a Discharge event, then the relevant portion of the hospitalization structure MUST be populated
    • Portions of the hospitalization structure which are irrelevant to this Encounter may be omitted.
    • In other words, depending on circumstances, the hospitalization structure might be:
      • Fully populated (for a simple standalone Encounter)
      • Half populated (for an Encounter that is the first or last of a set)
      • Not populated at all (more rarely, for an Encounter that is “in the middle” of a set)
  • Grouping Option 1 - Encounter Grouping (linking in time)

    Despite the appeal of a simple flat list of Encounters, the concept of a “visit”, “hospitalisation”, or “incident” is widely recognised and agreed to be useful as a way of grouping Encounters that are linked in time. For example:

    • An initial “emergency” visit to A&E is followed by admittance to the ward as an inpatient
    • An initial call to 111 is followed by a visit at home from a first-responder, and finally a conveyance to hospital in an ambulance

    A two-level hierarchy is therefore defined, based on the use of special type of Grouping Encounter to link together Encounters which comprise part of the same “visit”, “stay” or “incident”.

    • A separate Encounter Grouping profile is provided to support this.
    • Data Providers who feel it is relevant MAY provide this additional grouping information
    • Data Consumers who are able MAY make use of this additional grouping information to provide a richer and more meaningful display to their users

    In practical terms:

    • The “partOf” field on the base Encounters is populated to point at a Grouping Encounter
    • Only a SINGLE level of Encounter hierarchy is supported. The “partOf” field of a base Encounter must point ONLY at a single Grouping Encounter. Other more complex structures are NOT supported
    • It is perfectly acceptable to have a Grouping Encounter which contains only a single base Encounter. In fact this is likely to be common - as when the initial encounter occurs it is not known how events will unfold. The simplest approach for a Maturity Level 2 Data Provider will therefore be to always create a Grouping Encounter in anticipation. With the grouping structure already in place, it becomes straightforward to add additional Encounters as-and-if they occur.
    • It is, of course, also acceptable to have a standalone Encounter with no Grouping Encounter - for example where an Encounter is not going to be part of any grouping and this is known from the start.
    • The Grouping Encounter is essentially an empty shell. Its purpose is purely to group. All of the important information is held in the base Encounters.
    • The Grouping Encounter does however add value by capturing the overall period and the full set of “hospitalization” information about admission and discharge. Whilst this could be deduced from the base encounters, it is helpful and logical to also provide in one place here.
  • Grouping Option 2 - Episode of Care (linking by condition)

    Another way of grouping Encounters goes beyond modelling a single visit or incident and links together a care pathway based on a Condition. This linkage is provided by the Episode of Care.

    At first glance it can be difficult to distinguish an Encounter Grouping from an Episode of Care - however the FHIR specification provides helpful guidance, and in fact there are some clear differentiating features:

    • An Episode of Care continues over a longer period of time. Specifically it can be used to link together multiple separate visits over a period of months or even years. For example an initial in-patient stay, and then several related out patient appointments, and then maybe another in-patient stay if there is a relapse.
    • An Episode of Care is based around a “condition” and is thus used to join-up a care pathway. Specifically, a patient with multiple conditions could have multiple Episodes of Care running concurrently. The Episode of Care is used to “pick out” from the mass of activity those Encounters relating to a particular care pathway. Therefore the Episode of Care MUST have its Condition field populated when using it to group Encounters in this way.

    • The FHIR Specification states that an Episode of Care relates to a single organisation, and this is how we envisage it being used initially.

    Longer term the definition of “organisation” might be considered a point of controversy, specifically is an Integrated Care System an “organisation”? This would provide a valuable mechanism to link up a cross-care-setting care pathway - noting that there is currently no obvious mechanism to identify and link encounters at this whole-system level. Extending an Episode of Care across multiple care settings in this way is therefore currently seen as aspiriational and unlikely to be implemented immediately. Please get in touch for further discussion if you believe you may be a first-of-type.

The diagram below summarises the above discussion - ie core Encounters, plus options for a single Grouping Encounter, and/or one or more Episodes of Care.

Encounter Structure

Encounters vs Appointments

Whilst the terms “Encounter” and “Appointment” might be used interchangeably in everyday speech, in FHIR they have specific meanings:

  • An Appointment describes a plan for the future
  • An Encounter generally describes something that is happening now, or has occurred in the past

In general therefore:

  • An Appointment will lead to an Encounter - when the patient attends
  • An Encounter may or may not come from an Appointment (ie scheduled vs unscheduled care)

The picture is further complicated as FHIR does allow an Encounter to be created with status “planned”, however this is not recommended here and should normally be represented instead with an Appointment.

Further useful guidance can be found on the FHIR website, here:

https://www.hl7.org/fhir/STU3/encounter.html#bnr

https://www.hl7.org/fhir/STU3/appointment.html#statuses

https://www.hl7.org/fhir/STU3/appointment.html#status-flow

Mandatory fields

A significant set of mandatory fields are defined in order to properly describe an Encounter:

  1. Status - this is already mandatory in FHIR. As noted above the use of “planned” is discouraged - use Appointment instead for this.

  2. Class - this provides a categorisation, ie Emergency, Inpatient, Ambulatory. This should always be known, and vital for meaningful display purposes. We have defined a custom code list which replicates the standard list provided by Care Connect, and adds a codes to identify an “Encounter Grouping”, and various types of ambulance/emergency service encounters. However it also enables the possibility of extending the list to cover a wider range of care settings if this is found to be necessary (please get in touch).

  3. Subject - every encounter must be linked to a Patient (not a Group)

  4. Participant - it is required to include EXACTLY ONE practitioner who has the “type” of “Primary Performer”. This should be the main person responsible - someone who it would be useful to contact if further information is desired. (If this person changed during the course of the encounter then please pick just ONE to finally hold this key role, and demote the others to “participant”)

    Also included in the list of participants might be:

    • Admitter and Discharger - should be included if known and relevant.
    • Participant - FHIR offers a wealth of other participant type codes, however it is suggested that simply classifying others as “participant” is likely to be adequate in most cases.

    Participants can be given a “period” and this is optional. For regional sharing the most important thing is to see who has been involved with the patient, rather than to construct a forensic timeline of involvements. However this information might be useful in the case of a long Encounter with many brief involvements, and so may be provided if desired.

  5. Period When the encounter occurred is vital to know. The start date/time is always mandatory, but as per the FHIR specification, the end date/time may be omitted if the encounter is ongoing

Must Support fields

In addition the following fields are “Must Support” - ie they must be populated if relevant and known. These largely relate to providing additional “clinical” detail about the Encounter - including links to related FHIR Resources such as the originating Appointment, the Condition, etc. These build up the rich dataset around an Encounter and are important to provide, but may not yet be available for an initial Encounter implementation.

  1. Identifier - a Local Id should be provided, such that could be quoted if manually getting in touch to find out more

  2. Type - categorises the type of place where the encounter took place. CareConnect modifies FHIR by providing a much more relevant list covering:
    • Indirect encounters - eg phone, video, letter, etc
    • In an establishment - a short list of top-level codes which cover a good range of care settings eg “Seen in clinic”, “Seen in own home”, “Seen in supervised accomodation”, etc.
    • On the street

      NB: The code for “Seen in Clinic” offers the ability to drill down into a long list of specific clinic types. However this overlaps to some extent with the purpose of the “Service Type” field - so it is sufficient here to populate simply “Seen in Clinic”.

  3. Service Type (Extension) - this is perhaps one of the most important and useful fields about an Encounter as it describes the type of service - ie what the Encounter was “for”.

    However this field is missing in FHIR STU3! This is corrected in FHIR R4, and so we pre-adopt it here as an extension.

    We also pre-adopt the UKCore value set (based on SNOMED refset 1127531000000102: Services Simple Reference Set), which is more relevant than the default FHIR example and also covers social care

  4. Priority: This provides useful information about whether it was emergency, routine, elective, etc

  5. Location - the location provides essential information about where the encounter took place. Exactly what is appropriate here will depend on the care setting:
    • For a hospital information should be provided down to the “ward” level. Thus enabling a visitor to find the patient, as well as potentially giving some insight into the type of treatment being provided.
    • For other (smaller) locations then the “site” level may be sufficient
    • Other types of care (eg community, emergency) may take place at home or in a vehicle

    It is useful to understand the history of where the patient has been seen, so the status and period MUST be populated, and a history SHOULD be provided. (As noted above, a change of location does not in itself constitute a new Encounter, simply append to this list).

  6. Appointment: Link to the originating Appointment, if relevant

  7. Reason: A long list of SNOMED codes to describe different reasons which may have led to the Encounter. (Note that this may duplicate to some extent information provided in a linked Appointment and/or Referral, but is seen as useful to pull through onto the Encounter itself also).

    We pre-adopt the value set used in R4. This builds on the existing STU3 list covering SNOMED codes for “Clinical Finding” and “Procedure”, and adds codes for “Context-dependent categories” (Social Care) and “Events” (A&E)

  8. Diagnosis: Link to a Condition diagnosed as a result of the Encounter. Can obviously be provided only if the Condition FHIR Resource is also being offered. If populated then it is required to rank the Conditions, and to assign one the “role” of “Chief Complaint”

  9. Outcome fields: Care Connect defines three extension fields which cover aspects of the encounter outcome:
    • Outcome of Attendance - relevant to outpatient encounters
    • Emergency Care Discharge Status - relevant to emergency encounters
    • Discharge Method - found in the “hospitalization”, and relevant to inpatient encounters

    These provide valuable information which is important to populate. However it is expected that only one of the three will be populated, as relevant for the type of encounter

    • Emergency Care Discharge Destination - This extension has been added to record the discharge destination of patients which have attended ED. (based on SNOMED refset 999003011000000105: Emergency care discharge destination simple reference set)
  10. Hospitalization: To provide details of admission and discharge. As described above then, depending on circumstances, it might be actually populated fully, partially, or not at all. See below for further details of the fields contained

  11. Status History - this is seen as important - to understand the timeline of the Encounter.

Optional fields

Other fields are optional and may be populated if known - on the understanding that not all data consumers will necessarily make use of them. Points of note include:

  • Part Of - as described above, this may be used to point to an overarching “EncounterGrouping” Encounter. No other complex structures or nesting are permitted.

  • Episode of Care - again as described above, this may be used to link up a care pathway by pointing to an Episode of Care.

  • Incoming Referral: Link to the originating Referral, if relevant and implemented. This could be very useful information. However FHIR makes significant changes from the STU3 “ReferralRequest” to the R4 “ServiceRequest”, and so we are reluctant to mandate implementation at this stage

  • Length - the period is already provided, so this may appear to be duplication. However it is encouraged to populate if possible as it is useful for analytic purposes. If provided then the duration SHOULD be in minutes, and should reflect the time the patient is receiving direct care - eg not including the time the patient is waiting to be seen in clinic. (This provides a further distinction and greater analytical accuracy over-and-above the “period”)

  • Encounter Transport - may be useful if relevant and known (however noting that it no longer exists in UK Core)

Discouraged or Removed fields

  • Class History - as described in the introduction, a change of care setting would constitute a new Encounter. Therefore by definition an Encounter will only ever have a single Class.
  • Account - for billing purposes, not relevant.
  • Service Provider - duplicates information already available in the provenance tags

Hospitalization Structure

Within the Encounter sits the “Hospitalization” structure. This structure provides information about the admission and discharge. Therefore it is particularly important for a regional shared record - as this defines the touchpoints with other care providers.

Fields in the Hospitalization structure are as follows:

  • Must Support
    • Admission Method - this CareConnect extension provides a useful list of codes about the method of admission (eg Planned, A&E, transfer, etc)
    • Discharge Method - this CareConnect extension provides a useful list of codes about the method of discharge relevant to an inpatient stay (eg clinical discharge, self-discharge, deceased, etc). It is one of three alternatives for providing outcome information, depending on the type of encounter - see above under the main encounter “must support” heading for further details.
    • Origin - Information about the location which the patient arrived from (if relevant / known)
      • Required at the “site” level if arriving from another institution
      • Optional if arriving from a residential address
    • Admit Source - Useful information about the type of place the patient came from (eg home, other NHS hospital, care home, etc)
    • Destination - Information about the location which the patient is discharged to (if relevant / known)
      • Required at the “site” level if discharged to another institution
      • Optional if discharged to a residential address
    • Discharge Disposition - Useful information about the type of place the patient has been discharged to (eg home, other NHS hospital, care home, etc)). (We use a value set which updates that provided by CareConnect with the latest improved list from the NHS Data Dictionary)
    • Medically Safe For Discharge - This extension has been added to capture important information to assist with discharge planning and analysis. It contains a status code (ready, not ready, or unknown), plus the predicted and actual date when the patient is medically safe for discharge.

    Note that Origin and Destination are likely to be external locations - please refer to guidance on the Location profile about use of References. For example the use of a Contained Resource may be appropriate.

  • Optional
    • Readmission - flag may be provided if known and relevant
  • Discouraged
    • Diet Preferences, Special Courtesy, Special Arrangement - additional details that are relevant internally for planning the patient’s stay, but not so relevant for external sharing.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from CareConnect-Encounter-1

NameFlagsCard.TypeDescription & Constraintsdoco
.. Encounter 0..*CareConnect-Encounter-1An interaction during which services are provided to the patient
... id S0..1idLogical id of this artifact
... meta
.... versionId S0..1idVersion specific identifier
.... lastUpdated S0..1instantMANDATORY except in Contained Resources. When the resource version last changed.
.... profile S0..*uriProfiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
.... security 0..*CodingDISCOURAGED - may not be honoured by Data Consumers
.... Slices for tag 0..*CodingTags applied to this resource
Slice: Unordered, Open by value:system
..... tag:Source S0..1CodingMANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
...... system 1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Source
...... code S1..1codeThe Data Provider Id of the system supplying the data
...... display S1..1stringName of the system supplying the data
..... tag:Provenance S0..1CodingMANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
...... system 1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Provenance
...... code S1..1codeThe ODS Code of the organisation responsible for the data
...... display S1..1stringName of the organisation supplying the data
... implicitRules 0..1uriDISCOURAGED - may not be honoured by Data Consumers
... language 0..1codeEnglish is assumed (not currently a multi-lingual implementation)
... text 0..1NarrativeDISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
... extension:outcomeOfAttendance S0..1Extension-CareConnect-OutcomeOfAttendance-1An extension to the Encounter resource to record the outcome of an Out-Patient attendance.
... extension:emergencyCareDischargeStatus S0..1Extension-CareConnect-EmergencyCareDischargeStatus-1An extension to the Encounter resource which is used indicate the status of the Patient on discharge from an Emergency Care Department.
... emergencyCareDischargeDestination S0..1CodeableConceptDischarge destination of patients which have attended ED.
URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-EDDischargeDestination
Binding: Interweave ED Discharge Destination (preferred)
... serviceType S0..1CodeableConceptSpecific type of service (pre-adopted from R4)
URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-R4EncounterServiceType
Binding: Interweave UkCore Care Setting Type (preferred)
... Slices for identifier 0..*IdentifierIdentifier(s) by which this encounter is known
Slice: Unordered, Open by value:system
.... identifier:localIdentifier S0..1IdentifierIdentifier(s) by which this encounter is known
..... system S1..1uriThe namespace for the identifier value
Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-encounter-identifier
..... value S1..1stringThe Local encounter Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
..... period 0..0
... status S1..1codearrived | triaged | in-progress | onleave | finished | cancelled + (Note: 'planned' is also possible, but normally represented instead as an Appointment)
... statusHistory S0..*BackboneElementList of past encounter statuses
... class S1..1CodingClassification of the encounter. EXTENSIBLE on request, eg to cover other care settings
Binding: InterweaveEncounterClass (required)
.... system 1..1uriIdentity of the terminology system
.... code 1..1codeSymbol in syntax defined by the system
.... display 1..1stringRepresentation defined by the system
... classHistory 0..0
... type S0..1CodeableConceptSpecific type of encounter
Binding: Care Connect Encounter Type (required)
.... coding 1..1CodingCode defined by a terminology system
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
.... coding:snomedCT S1..*CodingCode defined by a terminology system
Binding: Care Connect Encounter Type (required)
... priority S0..1CodeableConceptIndicates the urgency of the encounter
Binding: InterweaveEncounterPriority (required)
.... coding
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
... subject S1..1Reference(CareConnectPatient1)The patient (NOT group) present at the encounter
.... reference 1..1stringReference to a resource (could be Contained)
.... identifier 0..1IdentifierIf relevant could include an id
.... display 1..1stringDescription of the referenced resource
... incomingReferral
.... reference 1..1stringReference to a resource (could be Contained)
.... identifier 0..1IdentifierIf relevant could include an id
.... display 0..1stringIf relevant, description of the referenced resource
... participant S1..*BackboneElementList of participants involved in the encounter
.... type S1..1CodeableConceptRole of participant in encounter
Binding: ParticipantType (required)
..... coding
...... system 1..1uriIdentity of the terminology system
...... code 1..1codeSymbol in syntax defined by the system
...... display 1..1stringRepresentation defined by the system
.... individual S1..1Reference(CareConnect-Practitioner-1)Persons involved in the encounter other than the patient
..... reference 1..1stringReference to a resource (could be Contained)
..... identifier 0..1IdentifierIf relevant could include an id
..... display 1..1stringDescription of the referenced resource
... appointment S0..1Reference(Appointment)The appointment that scheduled this encounter
.... reference 1..1stringReference to a resource (could be Contained)
.... identifier 0..1IdentifierIf relevant could include an id
.... display 0..1stringIf relevant, description of the referenced resource
... period S1..1PeriodThe start and end time of the encounter
.... start S1..1dateTimeStarting time with inclusive boundary
.... end S0..1dateTimeEnd time with inclusive boundary, if not ongoing
... length 0..1DurationQuantity of time the encounter lasted (less time absent). Please use minutes.
... reason S0..*CodeableConceptReason the encounter takes place (code)
Binding: Interweave R4 Encounter Reason (preferred)
.... coding 0..*CodingCode defined by a terminology system
..... system 1..1uriIdentity of the terminology system
..... code 1..1codeSymbol in syntax defined by the system
..... display 1..1stringRepresentation defined by the system
... Slices for diagnosis S0..*BackboneElementThe list of diagnosis relevant to this encounter
Slice: Unordered, Open by value:role
.... diagnosis:All Slices Content/Rules for all slices
..... condition S1..1Reference(CareConnect-Condition-1)Reason the encounter takes place (resource)
...... reference 1..1stringReference to a resource (could be Contained)
...... identifier 0..1IdentifierIf relevant could include an id
...... display 0..1stringIf relevant, description of the referenced resource
..... role S1..1CodeableConceptRole that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
Binding: DiagnosisRole (required)
...... coding
....... system 1..1uriIdentity of the terminology system
....... code 1..1codeSymbol in syntax defined by the system
....... display 1..1stringRepresentation defined by the system
..... rank S1..1positiveIntRanking of the diagnosis (for each role type)
.... diagnosis:chiefComplaint S0..1BackboneElementThe list of diagnosis relevant to this encounter
..... role 0..1CodeableConceptRole that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
Fixed Value: As shown
...... coding1..1CodingCode defined by a terminology system
Fixed Value: (complex)
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/diagnosis-role
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: CC
....... display1..1stringRepresentation defined by the system
Fixed Value: Chief complaint
... account 0..0
... hospitalization S0..1BackboneElementDetails about the admission to a healthcare service
.... extension:admissionMethod S0..1Extension-CareConnect-AdmissionMethod-1An extension to the Encounter resource to record how a Patient was admitted to hospital.
.... extension:dischargeMethod S0..1Extension-CareConnect-DischargeMethod-1An extension to the Encounter resource to record the method of discharge from hospital.
.... medicallySafeForDischarge S0..1(Complex)Medically Safe for Discharge
URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-MedicallySafeForDischarge
.... origin 0..1Reference(CareConnect-Location-1)The location from which the patient came before admission. Useful to provide if possible, in particular to reference a 'site' if transfered from another institution.
..... reference 1..1stringReference to a resource (could be Contained)
..... identifier 0..1IdentifierIf relevant could include an id
..... display 1..1stringDescription of the referenced resource
.... admitSource S0..1CodeableConceptFrom where patient was admitted (physician referral, transfer)
Binding: NHS Data Model and Dictionary Source Of Admission (required)
..... coding
...... system 1..1uriIdentity of the terminology system
...... code 1..1codeSymbol in syntax defined by the system
...... display 1..1stringRepresentation defined by the system
.... dietPreference 0..*CodeableConceptDISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing
.... specialCourtesy 0..*CodeableConceptDISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing
.... specialArrangement 0..*CodeableConceptDISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing
.... destination S0..1Reference(CareConnect-Location-1)Location to which the patient is discharged. Important to provide if known to support discharge planning, and/or to reference a 'site' if transfered to another institution.
..... reference 1..1stringReference to a resource (could be Contained)
..... identifier 0..1IdentifierIf relevant could include an id
..... display 1..1stringDescription of the referenced resource
.... dischargeDisposition S0..1CodeableConceptCategory or kind of location after discharge
Binding: Interweave Discharge Destination codes (required)
..... coding
...... system 1..1uriIdentity of the terminology system
...... code 1..1codeSymbol in syntax defined by the system
...... display 1..1stringRepresentation defined by the system
... location S0..*BackboneElementLocation the encounter takes place (at Ward level)
.... location S1..1Reference(CareConnect-Location-1)Location the encounter takes place
..... reference 1..1stringReference to a resource (could be Contained)
..... identifier 0..1IdentifierIf relevant could include an id
..... display 1..1stringDescription of the referenced resource
.... status S1..1codeplanned | active | reserved | completed
.... period S1..1PeriodTime period during which the patient was present at the location
... serviceProvider 0..1Reference(CareConnect-Organization-1)DISCOURAGED: This is instead covered via the provenance tags
... partOf 0..1Reference(InterweaveEncounterGrouping)Another Encounter this encounter is part of
.... reference 1..1stringReference to a resource (could be Contained)
.... identifier 0..1IdentifierIf relevant could include an id
.... display 0..1stringIf relevant, description of the referenced resource

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
Encounter.classrequiredInterweaveEncounterClass
Encounter.typerequiredCare Connect Encounter Type
Encounter.type.coding:snomedCTrequiredCare Connect Encounter Type
Encounter.priorityrequiredInterweaveEncounterPriority
Encounter.participant.typerequiredParticipantType
Encounter.reasonpreferredInterweave R4 Encounter Reason
Encounter.diagnosis.rolerequiredDiagnosisRole
Encounter.hospitalization.admitSourcerequiredNHS Data Model and Dictionary Source Of Admission
Encounter.hospitalization.dischargeDispositionrequiredInterweave Discharge Destination codes
NameFlagsCard.TypeDescription & Constraintsdoco
.. Encounter 0..*CareConnect-Encounter-1An interaction during which services are provided to the patient
... id SΣ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... versionId SΣ0..1idVersion specific identifier
.... lastUpdated SΣ0..1instantMANDATORY except in Contained Resources. When the resource version last changed.
.... profile SΣ0..*uriProfiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
.... security Σ0..*CodingDISCOURAGED - may not be honoured by Data Consumers
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... Slices for tag Σ0..*CodingTags applied to this resource
Slice: Unordered, Open by value:system
Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"


..... tag:Source SΣ0..1CodingMANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"


...... system Σ1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Source
...... code SΣ1..1codeThe Data Provider Id of the system supplying the data
...... display SΣ1..1stringName of the system supplying the data
..... tag:Provenance SΣ0..1CodingMANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"


...... system Σ1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Provenance
...... code SΣ1..1codeThe ODS Code of the organisation responsible for the data
...... display SΣ1..1stringName of the organisation supplying the data
... implicitRules ?!Σ0..1uriDISCOURAGED - may not be honoured by Data Consumers
... language 0..1codeEnglish is assumed (not currently a multi-lingual implementation)
Binding: Common Languages (extensible): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeDISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
... encounterTransport 0..1(Complex)Encounter transport
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-EncounterTransport-1
... outcomeOfAttendance S0..1CodeableConceptAn extension to the Encounter resource to record the outcome of an Out-Patient attendance.
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-OutcomeOfAttendance-1
Binding: NHS Data Model and Dictionary Outcome Of Attendance (required): This records the outcome of an Out-Patient Attendance Consultant.


... emergencyCareDischargeStatus S0..1CodeableConceptAn extension to the Encounter resource which is used indicate the status of the Patient on discharge from an Emergency Care Department.
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-EmergencyCareDischargeStatus-1
Binding: Care Connect Emergency Care Discharge Status (required): The status of the Patient on discharge from an Emergency Care Department.


... emergencyCareDischargeDestination S0..1CodeableConceptDischarge destination of patients which have attended ED.
URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-EDDischargeDestination
Binding: Interweave ED Discharge Destination (preferred)
... serviceType S0..1CodeableConceptSpecific type of service (pre-adopted from R4)
URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-R4EncounterServiceType
Binding: Interweave UkCore Care Setting Type (preferred)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier Σ0..*IdentifierIdentifier(s) by which this encounter is known
Slice: Unordered, Open by value:system
.... identifier:All Slices Content/Rules for all slices
..... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... system Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ1..1stringThe value that is unique
Example General: 123456
.... identifier:localIdentifier SΣ0..1IdentifierIdentifier(s) by which this encounter is known
..... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... system SΣ1..1uriThe namespace for the identifier value
Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-encounter-identifier
..... value SΣ1..1stringThe Local encounter Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
Example General: 123456
... status ?!SΣ1..1codearrived | triaged | in-progress | onleave | finished | cancelled + (Note: 'planned' is also possible, but normally represented instead as an Appointment)
Binding: EncounterStatus (required): Current state of the encounter

... statusHistory S0..*BackboneElementList of past encounter statuses
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... status 1..1codeplanned | arrived | triaged | in-progress | onleave | finished | cancelled +
Binding: EncounterStatus (required): Current state of the encounter

.... period 1..1PeriodThe time that the episode was in the specified status
... class SΣ1..1CodingClassification of the encounter. EXTENSIBLE on request, eg to cover other care settings
Binding: InterweaveEncounterClass (required)
.... system Σ1..1uriIdentity of the terminology system
.... code Σ1..1codeSymbol in syntax defined by the system
.... display Σ1..1stringRepresentation defined by the system
... type SΣ0..1CodeableConceptSpecific type of encounter
Binding: Care Connect Encounter Type (required)
.... Slices for coding Σ1..1CodingCode defined by a terminology system
Slice: Unordered, Open by value:system
..... coding:All Slices Content/Rules for all slices
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
..... coding:snomedCT SΣ1..*CodingCode defined by a terminology system
Binding: Care Connect Encounter Type (required)
...... snomedCTDescriptionID 0..*(Complex)The SNOMED CT Description ID for the display
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
...... system Σ1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
... priority S0..1CodeableConceptIndicates the urgency of the encounter
Binding: InterweaveEncounterPriority (required)
... subject SΣ1..1Reference(CareConnectPatient1)The patient (NOT group) present at the encounter
.... reference ΣC1..1stringReference to a resource (could be Contained)
.... identifier Σ0..1IdentifierIf relevant could include an id
.... display Σ1..1stringDescription of the referenced resource
... participant SΣ1..*BackboneElementList of participants involved in the encounter
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type SΣ1..1CodeableConceptRole of participant in encounter
Binding: ParticipantType (required)
.... individual SΣ1..1Reference(CareConnect-Practitioner-1)Persons involved in the encounter other than the patient
..... reference ΣC1..1stringReference to a resource (could be Contained)
..... identifier Σ0..1IdentifierIf relevant could include an id
..... display Σ1..1stringDescription of the referenced resource
... appointment SΣ0..1Reference(Appointment)The appointment that scheduled this encounter
.... reference ΣC1..1stringReference to a resource (could be Contained)
.... identifier Σ0..1IdentifierIf relevant could include an id
.... display Σ0..1stringIf relevant, description of the referenced resource
... period S1..1PeriodThe start and end time of the encounter
.... start SΣC1..1dateTimeStarting time with inclusive boundary
.... end SΣC0..1dateTimeEnd time with inclusive boundary, if not ongoing
... length 0..1DurationQuantity of time the encounter lasted (less time absent). Please use minutes.
... reason SΣ0..*CodeableConceptReason the encounter takes place (code)
Binding: Interweave R4 Encounter Reason (preferred)
.... Slices for coding Σ0..*CodingCode defined by a terminology system
Slice: Unordered, Open by value:system
..... coding:All Slices Content/Rules for all slices
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
..... coding:snomedCT Σ0..1CodingCode defined by a terminology system
...... snomedCTDescriptionID 0..*(Complex)The SNOMED CT Description ID for the display
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
...... system Σ1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
... Slices for diagnosis SΣ0..*BackboneElementThe list of diagnosis relevant to this encounter
Slice: Unordered, Open by value:role
.... diagnosis:All Slices Content/Rules for all slices
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... condition S1..1Reference(CareConnect-Condition-1)Reason the encounter takes place (resource)
...... reference ΣC1..1stringReference to a resource (could be Contained)
...... identifier Σ0..1IdentifierIf relevant could include an id
...... display Σ0..1stringIf relevant, description of the referenced resource
..... role S1..1CodeableConceptRole that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
Binding: DiagnosisRole (required)
..... rank S1..1positiveIntRanking of the diagnosis (for each role type)
.... diagnosis:chiefComplaint SΣ0..1BackboneElementThe list of diagnosis relevant to this encounter
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... condition 1..1Reference(CareConnect-Procedure-1 | CareConnect-Condition-1)Reason the encounter takes place (resource)
..... role 0..1CodeableConceptRole that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents


Fixed Value: As shown
...... id0..0stringxml:id (or equivalent in JSON)
...... extension0..0ExtensionAdditional Content defined by implementations
...... coding1..1CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..0stringxml:id (or equivalent in JSON)
....... extension0..0ExtensionAdditional Content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/diagnosis-role
....... version0..0stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax defined by the system
Fixed Value: CC
....... display1..1stringRepresentation defined by the system
Fixed Value: Chief complaint
....... userSelected0..0booleanIf this coding was chosen directly by the user
...... text0..0stringPlain text representation of the concept
... hospitalization S0..1BackboneElementDetails about the admission to a healthcare service
.... admissionMethod S0..1CodeableConceptAn extension to the Encounter resource to record how a Patient was admitted to hospital.
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-AdmissionMethod-1
Binding: NHS Data Model and Dictionary Admission Method (required): The method of admission to a Hospital Provider Spell.


.... dischargeMethod S0..1CodeableConceptAn extension to the Encounter resource to record the method of discharge from hospital.
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-DischargeMethod-1
Binding: NHS Data Model and Dictionary Discharge Method (required): The method of discharge from a Hospital Provider Spell.


.... medicallySafeForDischarge S0..1(Complex)Medically Safe for Discharge
URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-MedicallySafeForDischarge
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... origin 0..1Reference(CareConnect-Location-1)The location from which the patient came before admission. Useful to provide if possible, in particular to reference a 'site' if transfered from another institution.
..... reference ΣC1..1stringReference to a resource (could be Contained)
..... identifier Σ0..1IdentifierIf relevant could include an id
..... display Σ1..1stringDescription of the referenced resource
.... admitSource S0..1CodeableConceptFrom where patient was admitted (physician referral, transfer)
Binding: NHS Data Model and Dictionary Source Of Admission (required)
.... dietPreference 0..*CodeableConceptDISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing
Binding: Diet (extensible)
.... specialCourtesy 0..*CodeableConceptDISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing
Binding: SpecialCourtesy (preferred): Special courtesies


.... specialArrangement 0..*CodeableConceptDISCOURAGED: Relevant for managing the patient's stay, but less so for regional sharing
Binding: SpecialArrangements (preferred): Special arrangements


.... destination S0..1Reference(CareConnect-Location-1)Location to which the patient is discharged. Important to provide if known to support discharge planning, and/or to reference a 'site' if transfered to another institution.
..... reference ΣC1..1stringReference to a resource (could be Contained)
..... identifier Σ0..1IdentifierIf relevant could include an id
..... display Σ1..1stringDescription of the referenced resource
.... dischargeDisposition S0..1CodeableConceptCategory or kind of location after discharge
Binding: Interweave Discharge Destination codes (required)
... location S0..*BackboneElementLocation the encounter takes place (at Ward level)
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... location S1..1Reference(CareConnect-Location-1)Location the encounter takes place
..... reference ΣC1..1stringReference to a resource (could be Contained)
..... identifier Σ0..1IdentifierIf relevant could include an id
..... display Σ1..1stringDescription of the referenced resource
.... status S1..1codeplanned | active | reserved | completed
Binding: EncounterLocationStatus (required): The status of the location.

.... period S1..1PeriodTime period during which the patient was present at the location
... serviceProvider 0..1Reference(CareConnect-Organization-1)DISCOURAGED: This is instead covered via the provenance tags
... partOf 0..1Reference(InterweaveEncounterGrouping)Another Encounter this encounter is part of
.... reference ΣC1..1stringReference to a resource (could be Contained)
.... identifier Σ0..1IdentifierIf relevant could include an id
.... display Σ0..1stringIf relevant, description of the referenced resource

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
Encounter.meta.securityextensibleAll Security Labels
Encounter.meta.tagexampleCommon Tags
Encounter.meta.tag:SourceexampleCommon Tags
Encounter.meta.tag:ProvenanceexampleCommon Tags
Encounter.languageextensibleCommon Languages
Additional Bindings Purpose
AllLanguages Max Binding
Encounter.identifier.userequiredIdentifierUse
Encounter.identifier:localIdentifier.userequiredIdentifierUse
Encounter.statusrequiredEncounterStatus
Encounter.statusHistory.statusrequiredEncounterStatus
Encounter.classrequiredInterweaveEncounterClass
Encounter.classHistory.classextensibleActEncounterCode
Encounter.typerequiredCare Connect Encounter Type
Encounter.type.coding:snomedCTrequiredCare Connect Encounter Type
Encounter.priorityrequiredInterweaveEncounterPriority
Encounter.participant.typerequiredParticipantType
Encounter.reasonpreferredInterweave R4 Encounter Reason
Encounter.diagnosis.rolerequiredDiagnosisRole
Encounter.diagnosis:chiefComplaint.rolepreferredFixed Value: CC("Chief complaint")
Encounter.hospitalization.admitSourcerequiredNHS Data Model and Dictionary Source Of Admission
Encounter.hospitalization.dietPreferenceextensibleDiet
Encounter.hospitalization.specialCourtesypreferredSpecialCourtesy
Encounter.hospitalization.specialArrangementpreferredSpecialArrangements
Encounter.hospitalization.dischargeDispositionrequiredInterweave Discharge Destination codes
Encounter.location.statusrequiredEncounterLocationStatus

Constraints

IdGradePath(s)DetailsRequirements
dom-1errorEncounterIf the resource is contained in another resource, it SHALL NOT contain any narrative
: contained.text.empty()
dom-2errorEncounterIf the resource is contained in another resource, it SHALL NOT contain nested Resources
: contained.contained.empty()
dom-3errorEncounterIf the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource
: contained.where(('#'+id in %resource.descendants().reference).not()).empty()
dom-4errorEncounterIf a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated
: contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
ele-1errorEncounter.extension:encounterTransport, Encounter.extension:outcomeOfAttendance, Encounter.extension:emergencyCareDischargeStatus, Encounter.statusHistory, Encounter.participant, Encounter.diagnosis, Encounter.diagnosis:chiefComplaint, Encounter.hospitalization, Encounter.hospitalization.extension:admissionMethod, Encounter.hospitalization.extension:dischargeMethod, Encounter.locationAll FHIR elements must have a @value or children
: hasValue() | (children().count() > id.count())
ext-1errorEncounter.extension:encounterTransport, Encounter.extension:outcomeOfAttendance, Encounter.extension:emergencyCareDischargeStatus, Encounter.hospitalization.extension:admissionMethod, Encounter.hospitalization.extension:dischargeMethodMust have either extensions or value[x], not both
: extension.exists() != value.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. Encounter 0..*CareConnect-Encounter-1An interaction during which services are provided to the patient
... id SΣ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... versionId SΣ0..1idVersion specific identifier
.... lastUpdated SΣ0..1instantMANDATORY except in Contained Resources. When the resource version last changed.
.... profile SΣ0..*uriProfiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
.... security Σ0..*CodingDISCOURAGED - may not be honoured by Data Consumers
Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.


.... Slices for tag Σ0..*CodingTags applied to this resource
Slice: Unordered, Open by value:system
Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"


..... tag:Source SΣ0..1CodingMANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data
Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"


...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Source
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1codeThe Data Provider Id of the system supplying the data
...... display SΣ1..1stringName of the system supplying the data
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... tag:Provenance SΣ0..1CodingMANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data
Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"


...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
Fixed Value: https://yhcr.nhs.uk/Provenance
...... version Σ0..1stringVersion of the system - if relevant
...... code SΣ1..1codeThe ODS Code of the organisation responsible for the data
...... display SΣ1..1stringName of the organisation supplying the data
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
... implicitRules ?!Σ0..1uriDISCOURAGED - may not be honoured by Data Consumers
... language 0..1codeEnglish is assumed (not currently a multi-lingual implementation)
Binding: Common Languages (extensible): A human language.

Additional BindingsPurpose
AllLanguagesMax Binding
... text 0..1NarrativeDISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
... contained 0..*ResourceContained, inline Resources
... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
... encounterTransport 0..1(Complex)Encounter transport
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-EncounterTransport-1
... outcomeOfAttendance S0..1CodeableConceptAn extension to the Encounter resource to record the outcome of an Out-Patient attendance.
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-OutcomeOfAttendance-1
Binding: NHS Data Model and Dictionary Outcome Of Attendance (required): This records the outcome of an Out-Patient Attendance Consultant.


... emergencyCareDischargeStatus S0..1CodeableConceptAn extension to the Encounter resource which is used indicate the status of the Patient on discharge from an Emergency Care Department.
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-CareConnect-EmergencyCareDischargeStatus-1
Binding: Care Connect Emergency Care Discharge Status (required): The status of the Patient on discharge from an Emergency Care Department.


... emergencyCareDischargeDestination S0..1CodeableConceptDischarge destination of patients which have attended ED.
URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-EDDischargeDestination
Binding: Interweave ED Discharge Destination (preferred)
... serviceType S0..1CodeableConceptSpecific type of service (pre-adopted from R4)
URL: https://fhir.yhcr.nhs.uk/StructureDefinition/Extension-Interweave-R4EncounterServiceType
Binding: Interweave UkCore Care Setting Type (preferred)
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier Σ0..*IdentifierIdentifier(s) by which this encounter is known
Slice: Unordered, Open by value:system
.... identifier:All Slices Content/Rules for all slices
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system Σ1..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value Σ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(CareConnect-Organization-1)Organization that issued id (may be just text)
.... identifier:localIdentifier SΣ0..1IdentifierIdentifier(s) by which this encounter is known
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ0..1codeusual | official | temp | secondary (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .

..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system SΣ1..1uriThe namespace for the identifier value
Fixed Value: https://fhir.yhcr.nhs.uk/Id/local-encounter-identifier
..... value SΣ1..1stringThe Local encounter Identifier. Please prefix with ODS code plus period (XXX.) to ensure unique
Example General: 123456
..... assigner Σ0..1Reference(CareConnect-Organization-1)Organization that issued id (may be just text)
... status ?!SΣ1..1codearrived | triaged | in-progress | onleave | finished | cancelled + (Note: 'planned' is also possible, but normally represented instead as an Appointment)
Binding: EncounterStatus (required): Current state of the encounter

... statusHistory S0..*BackboneElementList of past encounter statuses
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... status 1..1codeplanned | arrived | triaged | in-progress | onleave | finished | cancelled +
Binding: EncounterStatus (required): Current state of the encounter

.... period 1..1PeriodThe time that the episode was in the specified status
... class SΣ1..1CodingClassification of the encounter. EXTENSIBLE on request, eg to cover other care settings
Binding: InterweaveEncounterClass (required)
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... system Σ1..1uriIdentity of the terminology system
.... version Σ0..1stringVersion of the system - if relevant
.... code Σ1..1codeSymbol in syntax defined by the system
.... display Σ1..1stringRepresentation defined by the system
.... userSelected Σ0..1booleanIf this coding was chosen directly by the user
... type SΣ0..1CodeableConceptSpecific type of encounter
Binding: Care Connect Encounter Type (required)
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ1..1CodingCode defined by a terminology system
Slice: Unordered, Open by value:system
..... coding:All Slices Content/Rules for all slices
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... coding:snomedCT SΣ1..*CodingCode defined by a terminology system
Binding: Care Connect Encounter Type (required)
...... id 0..1stringxml:id (or equivalent in JSON)
...... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
...... snomedCTDescriptionID 0..*(Complex)The SNOMED CT Description ID for the display
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
...... system Σ1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... priority S0..1CodeableConceptIndicates the urgency of the encounter
Binding: InterweaveEncounterPriority (required)
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ0..*CodingCode defined by a terminology system
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... system Σ1..1uriIdentity of the terminology system
..... version Σ0..1stringVersion of the system - if relevant
..... code Σ1..1codeSymbol in syntax defined by the system
..... display Σ1..1stringRepresentation defined by the system
..... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... subject SΣ1..1Reference(CareConnectPatient1)The patient (NOT group) present at the encounter
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC1..1stringReference to a resource (could be Contained)
.... identifier Σ0..1IdentifierIf relevant could include an id
.... display Σ1..1stringDescription of the referenced resource
... episodeOfCare Σ0..*Reference(EpisodeOfCare)Episode(s) of care that this encounter should be recorded against
... incomingReferral 0..*Reference(ReferralRequest)The ReferralRequest that initiated this encounter
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC1..1stringReference to a resource (could be Contained)
.... identifier Σ0..1IdentifierIf relevant could include an id
.... display Σ0..1stringIf relevant, description of the referenced resource
... participant SΣ1..*BackboneElementList of participants involved in the encounter
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... type SΣ1..1CodeableConceptRole of participant in encounter
Binding: ParticipantType (required)
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... coding Σ0..*CodingCode defined by a terminology system
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... text Σ0..1stringPlain text representation of the concept
.... period 0..1PeriodPeriod of time during the encounter that the participant participated
.... individual SΣ1..1Reference(CareConnect-Practitioner-1)Persons involved in the encounter other than the patient
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
..... reference ΣC1..1stringReference to a resource (could be Contained)
..... identifier Σ0..1IdentifierIf relevant could include an id
..... display Σ1..1stringDescription of the referenced resource
... appointment SΣ0..1Reference(Appointment)The appointment that scheduled this encounter
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... reference ΣC1..1stringReference to a resource (could be Contained)
.... identifier Σ0..1IdentifierIf relevant could include an id
.... display Σ0..1stringIf relevant, description of the referenced resource
... period S1..1PeriodThe start and end time of the encounter
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... start SΣC1..1dateTimeStarting time with inclusive boundary
.... end SΣC0..1dateTimeEnd time with inclusive boundary, if not ongoing
... length 0..1DurationQuantity of time the encounter lasted (less time absent). Please use minutes.
... reason SΣ0..*CodeableConceptReason the encounter takes place (code)
Binding: Interweave R4 Encounter Reason (preferred)
.... id 0..1stringxml:id (or equivalent in JSON)
.... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
.... Slices for coding Σ0..*CodingCode defined by a terminology system
Slice: Unordered, Open by value:system
..... coding:All Slices Content/Rules for all slices
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... system Σ1..1uriIdentity of the terminology system
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
..... coding:snomedCT Σ0..1CodingCode defined by a terminology system
...... id 0..1stringxml:id (or equivalent in JSON)
...... Slices for extension 0..*ExtensionExtension
Slice: Unordered, Open by value:url
...... snomedCTDescriptionID 0..*(Complex)The SNOMED CT Description ID for the display
URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
...... system Σ1..1uriIdentity of the terminology system
Fixed Value: http://snomed.info/sct
...... version Σ0..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
...... userSelected Σ0..1booleanIf this coding was chosen directly by the user
.... text Σ0..1stringPlain text representation of the concept
... Slices for diagnosis SΣ0..*BackboneElementThe list of diagnosis relevant to this encounter
Slice: Unordered, Open by value:role
.... diagnosis:All Slices Content/Rules for all slices
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... condition S1..1Reference(CareConnect-Condition-1)Reason the encounter takes place (resource)
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... reference ΣC1..1stringReference to a resource (could be Contained)
...... identifier Σ0..1IdentifierIf relevant could include an id
...... display Σ0..1stringIf relevant, description of the referenced resource
..... role S1..1CodeableConceptRole that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
Binding: DiagnosisRole (required)
...... id 0..1stringxml:id (or equivalent in JSON)
...... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
...... coding Σ0..*CodingCode defined by a terminology system
....... id 0..1stringxml:id (or equivalent in JSON)
....... extension 0..*ExtensionAdditional Content defined by implementations
Slice: Unordered, Open by value:url
....... system Σ1..1uriIdentity of the terminology system
....... version Σ0..1stringVersion of the system - if relevant
....... code Σ1..1codeSymbol in syntax defined by the system
....... display Σ1..1stringRepresentation defined by the system
....... userSelected Σ0..1booleanIf this coding was chosen directly by the user
...... text Σ0..1stringPlain text representation of the concept
..... rank S1..1positiveIntRanking of the diagnosis (for each role type)
.... diagnosis:chiefComplaint SΣ0..1BackboneElementThe list of diagnosis relevant to this encounter
..... id 0..1stringxml:id (or equivalent in JSON)
..... extension 0..*ExtensionAdditional Content defined by implementations
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... condition 1..1Reference(CareConnect-Procedure-1 | CareConnect-Condition-1)Reason the encounter takes place (resource)
..... role 0..1CodeableConceptRole that this diagnosis has within the encounter (e.g. admission, billing, discharge …)
Binding: DiagnosisRole (preferred): The type of diagnosis this condition represents


Fixed Value: As shown
...... id0..0stringxml:id (or equivalent in JSON)
...... extension0..0ExtensionAdditional Content defined by implementations
...... coding1..1CodingCode defined by a terminology system
Fixed Value: (complex)
....... id0..0stringxml:id (or equivalent in JSON)
....... extension0..0ExtensionAdditional Content defined by implementations
....... system1..1uriIdentity of the terminology system
Fixed Value: http://hl7.org/fhir/diagnosis-role
....... version0..0stringVersion of the system - if relevant
....... code1..1codeSymbol in syntax define